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General NPI Number Information
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NPI Number | 1821585795
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Entity Type | Individual
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Provider Name | PHUONG CELINE NGUYEN
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Gender | Female
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Dates
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Enumeration Date | 04/17/2018
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Last Update Date | 04/17/2018
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Provider Practice Location Address
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Address Line | 7000 E MAYO BLVD STE 1034
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City | PHOENIX
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State | AZ
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Zip | 85054-6153
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Country | US
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Telephone | 480-513-3106
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Fax |
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Provider Business Mailing Address
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Address Line | 4973 E. ROSEMONTE DRIVE
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City | PHOENIX
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State | AZ
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Zip | 85050-6153
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Country | US
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Telephone | 858-776-2502
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 2238
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License Number State | AZ
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